key: cord-0305787-mgr5tbx7 authors: Gersten, O.; Barbieri, M. title: The Epidemiologic Transition Theory and Evidence for Cancer Transitions in the US, Select European Nations, and Japan date: 2020-11-29 journal: nan DOI: 10.1101/2020.11.25.20238832 sha: 2d307f47470bf3fae503fcb8ae69da06361a6783 doc_id: 305787 cord_uid: mgr5tbx7 Despite cancer being a leading cause of death worldwide, scant research has been carried out on the existence of 'cancer transitions,' the idea that as nations develop, they move from a situation where infectious related cancers are prominent, to one where non-infectious related cancers dominate. We use annual cause-of-death data to produce death rates for common types of cancer in select high-income countries. We find that cancer mortality patterns parallel the epidemiologic transition, which states that as countries advance, they move from a regime where infectious diseases are most common to one where non-infectious disease are most common. An implication is that the epidemiologic transition theory as originally formulated continues to be relevant despite some researchers arguing that we need additional stages beyond the original three. infection is often an important cause of cancer. 14 For instance, we now know that the bacterium 48 Helicobacter pylori (H. pylori), hepatitis B and C viruses, and human papillomavirus are 49 important causes of cancers of the stomach, liver, and cervix, respectively. The number of new 50 cancer cases in 2012 attributable to infectious agents was about 79% for stomach cancer, 73% 51 for liver cancer, and 100% for cervix uteri cancer. 14 52 Gersten and Wilmoth 15 first introduced and developed the concept of the "cancer 53 transition," which they meant to be analogous to Omran's epidemiologic transition. The authors 54 analyzed cancer trends in Japan from 1951 until 1997 and found that cancers with a root in 55 infectious causes were declining, while those with a root in non-infectious causes were 56 increasing. There has thus been a playing out of the epidemiologic transition within the broad 57 and complex set of diseases that define cancer. 58 Work investigating and attempting to extend the cancer transition theory has been 59 exceptionally limited, perhaps numbering no more than a few papers. One book chapter, though, 60 that has seriously engaged with the theory is that by Knaul and colleagues 16 which at one point 61 presents cross-sectional data from GLOBOCAN (2008) suggesting that cancers with a root in 62 infectious causes become less prominent as many nations move along the gradient from less to 63 more developed. A similar finding has been reported by Fidler and others 17 in a more recent 64 paper using a different dataset. 65 Bray and co-authors 4 also extend the cancer transition literature. They analyze four levels The aim of the paper here, then, is to contribute to the nascent literature on cancer 73 transition theory, and in so doing, examine the relevance of Omran's epidemiologic transition 74 theory. The paper focuses on evidence of cancer transition in the US, select European nations, 75 and Japan, differentiating between cancers with an infectious root and other cancers. We define 76 the cancer transition as the mid-point at which a country's population moves from a situation 77 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted November 29, 2020. ; https://doi.org/10.1101/2020.11.25.20238832 doi: medRxiv preprint 3 where rates of infectious-related cancers are greater than those of non-infectious cancers, to the 78 converse situation where rates of non-infectious cancers are higher. Results 81 82 Figure 1 shows trends in the age-standardized death rates from infectious-related and 83 non-infectious related cancers for all ages and both sexes combined in the six countries 84 investigated here. In all countries, mortality from infectious-related cancers has declined steadily 85 throughout the time period, except for Japan. At the beginning of the study period, the age-86 standardized death rates from cancers with a root in infectious causes ranged from about 50 per 87 100,000 in the US to 160 per 100,000 in Japan, a ratio of 1 to 3.2. Note, however, that the series 88 starts in 1959 in the former country, but in 1950 for the latter one. In Japan, the only country 89 where mortality from these cancers increased, the peak was reached at around 180 per 100,000 in Japan. The discontinuity in the data is most visible for Japan and France, and is due to changes in 93 the classification of liver cancer . 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted November 29, 2020. ; https://doi.org/10.1101/2020.11.25.20238832 doi: medRxiv preprint At the beginning of the study period, all countries exhibited an increasing trend in the 130 non-infectious related cancers, with a maximum reached circa 1985 in England and Wales. Most 131 of the other countries experienced a peak around 1990, or a few years later in the case of Japan. In all but the US and England and Wales, mortality from non-infectious related cancers were at 133 lowest at the beginning of the study period. Initial rates varied more than for infectious-related 134 cancers, ranging from about 40 per 100,000 in Japan to about 170 per 100,000 in England and 135 Wales, a ratio of 1 to 4.25. The peak also varied from one country to another, with a minimum of 136 nearly 120 per 100,000 in Japan (from the mid-1990s to the end of the study period) up to over In this study we used temporal cancer-specific mortality data to assess whether there is 149 supporting evidence of a cancer transition in the US, England and Wales, France, Norway, 150 Sweden, and Japan. Overall, there is compelling evidence supporting the cancer transition 151 theory. Of the over one hundred cancers responsible for the total cancer burden, the nine cancers Visually, Japan exhibits the most obvious cancer transition in the countries we examined 160 since its trends intersect later in the time period for which we have recorded data and most 161 closely resembles an "X" pattern. Norway is the only other country where a cancer transition 162 cross-over is visible, but it is easy to imagine that similar intersections would be observed 163 elsewhere, were additional historical data available. If Japan might be considered a "laggard" in 164 terms of its cancer transition, the US or England and Wales might be considered "forerunners," 165 since their transitions appear to have taken place in the first half of the twentieth century, prior to 166 mortality data becoming available if one extrapolates back from visible trends. 167 We can go further in our description of cancer transitions by making some 168 generalizations about their evolution: 1) initially, infectious-related cancer mortality rates are 169 high and non-infectious-related cancer mortality are low; 2) then, infectious-related cancer 170 mortality starts declining, while non-infectious cancer mortality increases, 3) subsequently, 171 infectious-related cancer mortality reaches a low level while non-infectious cancer mortality 172 starts declining after reaching its peak. Of primary importance in our paper was the grouping and analysis of infectious-related 174 versus non-infectious related cancers to identify signs of cancer transition. A caveat to such an 175 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted November 29, 2020. ; https://doi.org/10.1101/2020.11.25.20238832 doi: medRxiv preprint 6 analysis is the extent to which the overall trends mask some of the underlying diversity in 176 individual cancers by sex (see Supplementary Figures 1-2) . Still, despite concealing individual 177 heterogeneity, grouping cancers with more or less infectious-orientated etiologies, shows a 178 concise picture of cancer transitions. To conceptualize the cancer transition that occurs as nations develop, we apply elements 180 of Omran's theory of the epidemiologic transition. 7 Omran proposed that there are three stages in 181 the epidemiologic transition, the last being a move to the "age of degenerative and man-made Emerging mainly from the anthropological literature is the idea that we are in a "third 197 transition," not to be confused with the "stages" of Omran's epidemiologic transition. 38,39 198 According to this literature, the first transition is one that predates the first stage described by Sweden, and declined markedly in France. 68 A substantial, positive trend, has been a reduction in 260 smoking prevalence that has resulted in lower lung cancer rates some thirty to forty years later. 69 261 Importantly, the ability to both detect and treat some cancers has improved dramatically, . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted November 29, 2020. ; https://doi.org/10.1101/2020.11.25.20238832 doi: medRxiv preprint with non-infectious causes. Cancers with a root in infectious causes included stomach, liver, and 301 cervical cancer, which together accounted for 19.7% of worldwide cancer deaths in 2018 1 Concerning the six cancers with a root in non-infectious causes that we analyze, those We are grateful to Freddie Bray and Ken Wachter for their comments on a draft of this paper, 319 and we wish to thank Yuan Zhang for organizing a synchronous, virtual session for the 2020 320 Population Association of America Annual Meeting at which this paper was presented orally. Lastly, we thank Miriam Rauch for providing vital support. We declare no competing interests . 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted November 29, 2020. ; https://doi.org/10.1101/2020.11.25.20238832 doi: medRxiv preprint World Health Organization (WHO) Mortality Database. Accessed on Lung Cancer and Epidemiology of Pancreatic Cancer: Global 400 Epidemiology of pancreatic cancer International cancer seminars: a focus on esophageal squamous cell carcinoma Alcohol, smoking and risk of oesophago-gastric cancer Prevention, and Screening Breast Cancer Epidemiology and Risk Factors Colorectal cancer, screening and primary care: A mini literature review Nutrients, Foods, and Colorectal Cancer 417 Prevention Epidemiology of Prostate Cancer Lifestyle and dietary factors in relation to prostate cancer risk Prospective investigation of risk factors for prostate cancer in the UK Comparison of the coding of death certificates related to 426 cancer in seven countries Influence of death certificate errors 428 on cancer mortality trends The Fourth Stage of the Epidemiologic Transition: 439 The Age of Delayed Degenerative Diseases Emerging and Re-443 Emerging Infectious Diseases: The Third Epidemiologic Transition Johns Hopkins University of Medicine 446 Deaths: Leading Causes for 2017. Department of Health and Human 449 Services Infectious Disease Mortality Trends 451 in the United States Emerging infectious 454 diseases: the Fifth stage of the epidemiologic transition? World Health Statistics 455 Quarterly Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-458 Epidemiology of Helicobacter pylori 460 infection Prevalence of Helicobacter pylori 462 Infection Worldwide: A Systematic Review of Studies with National Coverage Helicobacter pylori: Epidemiology and Routes of Transmission Dietary Factors Act Synergistically to Promote Gastric Cancer Global Burden of Human Papillomavirus and Related Diseases. Vaccine: 30 Update on adolescent immunizations: 473 selected review of US recommendations and literature New 476 prophylactics human papilloma virus (HPV) vaccines against cervical cancer 50 years of 479 screening in the Nordic countries: quantifying the effects on cervical cancer incidence Tumour virus vaccines: hepatitis B virus and human papillomavirus Disease Burden of Hepatocellular 487 Carcinoma: A Global Perspective Hepatitis B vaccination and prevention of hepatocellular carcinoma Time trends of chronic HBV 491 infection over prior decades -A global analysis What Is Needed to Eliminate Hepatitis B Virus Hepatitis C Virus as Global Health Threats Physical Activity in the 495 Japan Population: Association with Blood Lipid Levels and Effects in Reducing Cardiovascular and All-Cause Mortality Status of Physical Activity in Japanese adults and children Global Physical Activity Levels -Need for 501 Intervention Worldwide trends in 503 insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-504 based surveys with 1.9 million participants The Nutrition Transition Implementing the Mediterranean Diet: A French Perspective and 508 Comparisons with The Western Diet and Chronic Kidney Is the British diet improving? Trends in adult body-mass index in 200 countries 515 from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 516 19.2 million participants Alcohol use and burden for 195 countries and 518 territories 1990 --2016: a systematic analysis for the Global Burden of Disease Study Global trends of lung cancer mortality and 521 smoking prevalence Milestones in Breast Cancer Treatment Colorectal Cancer 525 Screening Prostate Cancer Screening Prostate Cancer Screening: Guidelines Review and Laboratory Issues: Clinical Chemistry 530 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprintThe copyright holder for this this version posted November 29, 2020. ; https://doi.org/10.1101/2020.11.25.20238832 doi: medRxiv preprint